New 'Relapse Prediction Marker' for Pediatric Crohn's Disease and Ulcerative Colitis Identified

Domestic medical professionals have discovered an indicator that can predict relapse after discontinuation of biological injectable drugs in pediatric patients with Crohn's disease and ulcerative colitis.

The research team led by Professors Kim Mijin and Choi Yeonho from the Department of Pediatrics at Samsung Medical Center announced on the 5th that in pediatric Crohn's disease and ulcerative colitis, when biological agents are used sufficiently from the early stages and then discontinued, the proportion of monocytes involved in immune function is related to disease relapse.

Pediatric Crohn's disease and ulcerative colitis refer to inflammatory bowel diseases in which about 25% of all patients are children and adolescents under the age of 20. Due to the high risk of relapse, it is difficult to stop treatment easily, and the longer the medication period, the greater the possibility of side effects due to the nature of the drugs, but patients and caregivers are anxious because they do not know when to discontinue the medication.

The research team evaluated 727 pediatric patients diagnosed with inflammatory bowel disease at Samsung Medical Center from January 2003 to December 2021, dividing them into relapse and non-relapse groups after discontinuation of biological agents, and assessed clinical characteristics, monocytes, and disease activity at the time of discontinuation.

Monocytes are involved in the upper inflammatory process in the immune response of inflammatory bowel disease. Patients with inflammatory bowel disease may relapse after confirming "deep remission" and discontinuing biological agents. This study investigated whether the proportion of monocytes could act as a "relapse predictor" in patients who experienced relapse after stopping biological agents.

As a result, the proportion of monocytes, absolute monocyte count, and monocyte/polymorphonuclear leukocyte (PMN) ratio at the time of discontinuation were significantly higher in patients who relapsed. Multivariate analysis showed that the monocyte percentage and PMN ratio were risk factors for relapse. In particular, it was confirmed that a blood monocyte proportion exceeding 8.15% at the time of discontinuation was associated with a high probability of relapse within six months despite symptom reduction.

Professor Kim Mijin explained, "Currently, at Samsung Medical Center, a top-down treatment strategy is used from the early stages for patients with moderate to severe inflammatory bowel disease to rapidly achieve deep remission and then attempt discontinuation. This study is part of efforts to establish criteria that can challenge a cure in the near future."

This study was published in the world-renowned immunology journal Frontiers in Immunology (IF=8.787).

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